AimsThe effects of initiating sacubitril/valsartan in patients with stable heart failure with reduced ejection fraction (HFrEF) on response to fluid and sodium expansion are unknown.Methods and resultsWe have explored changes in natriuresis, diuresis, and congestion in response to the administration of intravenous fluid/sodium load in patients with HFrEF before as compared to after the initiation of sacubitril/valsartan. At baseline (before sacubitril/valsartan initiation) and 2 and 3 months after the initiation, patients underwent an evaluation that consisted of three phases of 3 h: the rest phase (0–3 h), the load phase (3–6 h) in which 1 L of intravenous Ringer solution was administered, and the diuretic phase (6–9 h) at the beginning of which furosemide was administered. Overall, 216 patients completed the study. In comparison to baseline values, at 2 and 3 months after sacubitril/valsartan initiation, patients' diuresis and natriuresis in response to Ringer administration significantly increased (mean difference: 38.8 [17.38] ml, p = 0.0040, and 9.6 [2.02] mmol, p < 0.0001, respectively). Symptoms and signs of congestion after the fluid/sodium challenge were significantly decreased at months 2 and 3 compared to baseline. Compared to baseline, there was also an increment of natriuresis after furosemide administration on sacubitril/valsartan (9.8 [5.13] mmol, p = 0.0167). There was a significant decrease in body weight in subsequent visits when compared to baseline values (−0.50 [−12.7, 7.4] kg at 2 months, and −0.75 [−15.9, 7.5] kg at 3 months; both p < 0.0001).ConclusionsThe initiation of sacubitril/valsartan in HFrEF patients was associated with improvements in natriuresis, diuresis, and weight loss and better clinical adaptation to potentially decongestive stressors.

中文翻译：

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开始使用沙库巴曲/缬沙坦后，慢性心力衰竭患者的充血减少并改善了对液体/钠挑战的反应：NATRIUM-HF 研究

目的 射血分数降低 (HFrEF) 的稳定型心力衰竭 (HFrEF) 患者开始使用沙库巴曲/缬沙坦对液体和钠扩张反应的影响尚不清楚。方法和结果我们探讨了静脉注射药物后钠排泄、利尿和充血的变化HFrEF 患者在开始使用沙库巴曲/缬沙坦之前与之后的液体/钠负荷。在基线（沙库巴曲/缬沙坦开始使用前）以及开始后 2 个月和 3 个月，患者接受了由三个 3 小时阶段组成的评估：休息阶段（0-3 小时）、负荷阶段（3-6 小时）其中静脉注射 1 L 林格液，利尿期（6-9 小时）开始施用呋塞米。总体而言，216 名患者完成了研究。与基线值相比，在开始沙库巴曲/缬沙坦治疗后 2 和 3 个月，患者对林格给药的利尿和尿钠排泄显着增加（平均差：38.8 [17.38] ml，p= 0.0040，和 9.6 [2.02] 毫摩尔，p< 0.0001，分别）。与基线相比，液体/钠挑战后的充血症状和体征在第 2 个月和第 3 个月显着减少。与基线相比，给予沙库巴曲/缬沙坦呋塞米后，尿钠排泄也有所增加（9.8 [5.13] mmol，p= 0.0167)。与基线值相比，随后就诊的体重显着下降（2 个月时为 -0.50 [−12.7, 7.4] kg，3 个月时为 -0.75 [−15.9, 7.5] kg；均p< 0.0001). 结论 HFrEF 患者开始使用沙库巴曲/缬沙坦与排尿钠、利尿和体重减轻的改善以及对潜在的减充血应激源的更好的临床适应相关。